CE Scholarship form

Application for Continuing Education Scholarship

Scholarships are available to fund some program costs and courses in the continuing education division. These courses have 4 digit course numbers at Central Piedmont, for example AUX-7200. You can review course offerings at this site: https://continuinged.cpcc.edu

To apply for financial aid and scholarships for credit programs (3 digit course numbers, ex: BUS 110) please visit www.cpcc.edu/scholarships

Please note this application only needs to be filled out ONE time for each person.

For any inquiries, please contact us at 704-330-4223 or via email at ContinuingEd@cpcc.edu

For questions about the application form (not scheduling), contact CE Scholarships Coordinator Kateryna Chepiha at 704-330-2722 ext. 3693 or via email kateryna.chepiha@cpcc.edu

Required fields are indicated with an asterisk (*).

Name*

First NameLast Name

Highest Education Level*

Do you have a Central Piedmont student ID number? *

Note: This should be a 7-digit number and often starts with a 3 or 4. Don’t have a Student ID number? Please contact CE Customer Service at 704-330-4223, or you can create one online: https://continuinged.cpcc.edu/portal/logon.do?method=load

What is your Central Piedmont student ID number?*

Email Address*

Please use your student email address, if you have one.

Date of Birth*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

YesNo

What is your Residency Certification Number (RCN)? (optional question)

Note: This is an optional question. One scholarship is for students with in-state NC tuition, you can complete residency determination at https://ncresidency.cfnc.org/residencyInfo/

Spring (January-May)Summer (May-July)Fall (August-December)

Note: Students typically receive one Continuing Education scholarship per semester. The first class you select will be consider your top choice. Final approval depends on course availability. To view available courses visit: https://continuinged.cpcc.edu

For programs include multiple courses (e.g. Massage Therapy, Central Sterile Processing, Insurance Planning etc.), please select the first course of the sequence.

To search for a class, start typing and the system will suggest available courses.

If you would like to take Personal Enrichment or ED2GO course, select in the drop-down menu "Other classes (Personal Enrichment and ed2go)" and then choose your desired class.

What course do you plan to take? *

What Personal Enrichment or ED2GO course do you plan to take? *

NoYes

What is the second course do you plan to take? *

NoYes

What is the third course do you plan to take? *

Please provide your position, place of employment, and the month and year your last employment ended*

Please indicate your present position and place of employment*

NoYes, I am a full-time employee at Central Piedmont Community CollegeYes, I am a part-time employee at Central Piedmont Community CollegeYes, I am a part-time work-study student or intern at Central Piedmont Community College

Please provide your job title and company name*

YesNo

What is your current Monthly Income (Individual Gross) before taxes?*

Note: Income questions do not disqualify applicants and help determine financial need.

What is your household size (including yourself)?*

YesNo

If yes, please explain*

I am applying to the Accelerated Career Training (ACT) ProgramI am receiving or eligible to receive SNAP/EBT/FNS (Food & Nutrition Services)I am receiving Work First or Refugee Employment ServicesI am an employee or child of an employee of Family Dollar/Dollar Tree storesI am an employee or my spouse, or parent, or guardian is employed by Snyder's-Lance/Campbell’s SnacksI am a director, employee or family member of an employee of SECU or the SECU foundationI am bilingual/multilingualNone of the above

Please upload the most recent pay stub from the Snyder’s‑Lance/Campbell’s Snacks or Family Dollar/Dollar Tree employee, even if you are the employee’s spouse, dependent, or child.*

Please indicate which language(s) you use or are proficient in*

Student Biography:

Please write a short student biography to tell us more about yourself. These questions are optional but might help you respond.

Tell us about your desire or need for this scholarship and any additional information that you think would be helpful.
How will completing this program help you achieve your educational, career, or vocational goals?
- What job or career would you like to have in the future?
- What inspired you to choose this career path?
- How have your personal experiences influenced your career path?
- How could this scholarship make a difference in your education or career plans?

Student Biography*

Please provide a thoughtful answer (minimum of 120 and a maximum of 250 words).0/320

NoYes

Please list the names of the scholarships, grants, or other funding sources you have received or expect to receive, and the amount (if known) *

I have a reliable transportation (access to bus is acceptable)I can meet program requirements (drug test, background check, fingerprinting)I live or work (or plan to work) in North CarolinaI would like to be contacted about other courses or programsNone of the above

Signature*

Please e-sign, acknowledging you agree that all information in this form is accurate. If you need accessibility assistance please contact: Continuing Education Customer Service at phone: 704-330-4223 or email: ContinuingEd@cpcc.edu

Date*

MonthDayYear

This application does not guarantee that you will be selected for a scholarship. It does not constitute a legal contract. Additional information may be required to determine eligibility. The application is subject to revision, and eligibility requirements may change without notice. Applicants will not be individually notified of any changes to the application or application process. It is the applicant’s responsibility to ensure that they are using the most current and up-to-date version of the application.

If you are experiencing technical issues submitting your application, please call Continuing Education Customer Service at phone: 704-330-4223
or email: ContinuingEd@cpcc.edu